Implementation Science Center in Cancer Control Equity: A Competitive Revision to Accelerate COVID Testing in Vulnerable Communities

Abstract: This competitive revision submitted to the RADx-UP Initiative (NOT-20-121) aims to extend the infrastructure ofour P50 Implementation Science Center for Cancer Control Equity (ISCCCE) to accelerate COVID testing in 9 hotspot communities in MA. ISCCCE is a strong partnership with the Massachusetts League of Community Health Centers, in which we co-design studies to increase implementation of evidence-based practices focused on equity. Together we are extremely well-positioned to extend our community-engaged efforts toCOVID-19 testing, and to build an infrastructure that will support future COVID-related mitigation and prevention efforts in the vulnerable communities that our community health centers (CHCs) serve. This project will include 6 community health center- community partnerships in nine vulnerable communities that continue to be COVID hot spots. These communities collectively have 1.3 million residents. Partner CHCs currently focus on COVID-19 testing for diagnostic purposes in symptomatic individuals, with limited outreach testing in high-risk communities. This project will expand the scope of testing to include prospective surveillance activities using dedicated testing and outreach teams. Accelerated testing efforts will be focused on CHC patients and community members who have significant social and medical vulnerabilities to COVID, per the NOSI, including those living in congregate housing, people experiencing homelessness, those with substance use disorders, low wage essential workers, and those with limited English proficiency. The partnership is well-integrated into the State's testing and contact tracing strategy, and well-positioned to leverage those resources. We draw on our strongly community-engaged, equity-focused approach to implementation, and on Mass League's extensive experience in HIV testing and contact tracing. We will use an interrupted time series design to evaluate the impact of the enhanced outreach efforts on testing rates overall and on priority populations in the context of different phases of re-opening and restrictions.We will also use an exploratory sequential mixed methods approach to conduct a series of community-engaged pilot studies to address key barriers to testing and different approaches to return of results. Our Human Participant Research Unit, co-led by academic and community-based investigators, will guide th epartnership's work through an ethics and equity lens. We will support the CHC-community partnershipsthrough our Testing Capacity and Innovation Team, which will provide infectious disease expertise and technical guidance on COVID testing. Our Community Communications Team will use educational andcommunication design strategies to develop culturally and linguistically appropriate materials to support the testing activities.